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Comparison of Physician and Patient Global Assessments Over Time in Patients With Rheumatoid Arthritis: A Retrospective Analysis From the RADIUS Cohort

Markenson, Joseph A. MD, FACP; Koenig, Andrew S. DO; Feng, Jing Yuan MS; Chaudhari, Sandeep MS; Zack, Debra J. MD, PhD; Collier, David MD; Weaver, Arthur MD

Journal of Clinical Rheumatology: September 2013 - Volume 19 - Issue 6 - p 317–323
doi: 10.1097/RHU.0b013e3182a2164f
Original Articles

Background In rheumatoid arthritis (RA), there is discordance between patient and physician assessments of disease severity and treatment response.

Objective This retrospective analysis of the RADIUS (RA Disease-Modifying Anti-Rheumatic Drug Intervention and Utilization Study) 1 cohort examined specific factors that influence differences in global assessments for therapeutic effectiveness of disease-modifying antirheumatic drugs made by physicians (physician global assessment [PhGA]) and patients (patient global assessment [PtGA]).

Methods The RADIUS 1 cohort consisted of primarily community-based private practice patients with RA requiring either the addition of or a switch to a new biologic or nonbiologic disease-modifying antirheumatic drug and who were followed for up to 5 years by their rheumatologists. Periodic assessments included PhGA, PtGA, Health Assessment Questionnaire–Disability Index (HAQ-DI), 28-item tender/painful joint count (TJC28), swollen joint count (SJC28), pain Visual Analog Scale (VAS), and acute-phase reactants.

Results Among 4359 patients (mean disease duration, 7.3 years), PhGA most highly correlated with TJC28 (0.6956; 95% confidence interval [CI], 0.6881–0.7030) and SJC28 (0.6757; 95% CI, 0.6678–0.6834). Moderate overall correlations were observed for PtGA with TJC28 (0.5000; 95% CI, 0.4890–0.5108) and less 50 with SJC28 (0.3754; 95% CI, 0.3628–0.3878). Patient global assessment most strongly correlated with pain VAS (0.8349; 95% CI, 0.8305–0.8392) and moderately correlated with HAQ-DI (0.5979; 95% CI, 0.5886–0.6071). Acute-phase reactants poorly correlated with PhGA and PtGA.

Conclusions Low correlations between PhGA and acute-phase reactants suggest that these measurements have a limited contribution compared with the physical examination when physicians make global assessments. These results also suggest that physicians should consider patients’ assessments of their disease activity (HAQ, pain VAS, and PtGA) and put joint counts into proper context.

This real life survey confirms that patient and physician global assessments vary. Pain and function are more important to patients. Acute phase reactants seemed to contribute little.

From the *Joan and Sanford Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY; †Pfizer Inc, Collegeville, PA; ‡Amgen Inc, Thousand Oaks, CA; §PharmaNet/i3, Tampa, FL; and ∥University of Nebraska Medical Center, Omaha, NE.

This study was sponsored by Immunex, a wholly owned subsidiary of Amgen Inc., and by Wyeth, which was acquired by Pfizer Inc., in October 2009.

J.A.M. has financial interests, relationships, and affiliations with the following organizations, including consultant status or speakers’ bureaus: Abbott, Amgen, AstraZeneca, Bristol-Myers-Squibb, Janssen, Novartis, Pfizer, and UCB. A.S.K. is an employee of and a shareholder in Pfizer Inc. J.Y.F. and D.C. are employees of and shareholders in Amgen Inc. D.J.Z. was employed by Amgen at the time the manuscript was developed. S.C., whose work was funded by Amgen, provided biostatistical support for this manuscript. A.W. has financial interests, relationships, and affiliations with 1 or more organizations, including consultant status, medical advisory boards, or speakers’ bureaus in Amgen, AstraZeneca, Genentech, Horizon Therapeutics, NiCox, Novartis, Pfizer, Primus Pharmaceuticals, Savient, Takeda, UCB, URL Pharma. A.W. is also on the board of directors of CORRONA.

Correspondence: Joseph A. Markenson, MD, FACP, Joan and Sanford Weill Medical College of Cornell University, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021. E-mail:

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.